Railed devices have one or two rails. The user necessarily grips the rail(s) with one or both hands for balance or to enable upper body weight bearing when support is needed. Adequate upper body function is therefore needed to use these devices and this is often lacking in the populations who use these devices. Various means to support a user's upper extremity and provide adequate rail contact are needed (such as forearm support and an accommodating grip handle for facilitating grip contact with the support surface) to enable stable support of a statically positioned UE or stable upper body support while a body moves relative to the rail(s) and thus to enable use of these railed devices by many more numbers and types of users. Also needed on all railed devices is enablement and facilitation of UE movement, such as needed for repetitive, reciprocating UE movement akin to arm swinging as well as for alternating UE placement. Movement of the UE and upper body is a component of normal gait kinematics and is desirable for multiple physiologic and mechanical reasons and is not currently enabled when support is needed on a treadmill. When walking along one or two rails, the user necessarily grips and releases the rail(s) in order to advance. This represents discontinuous support as opposed to continuous support such as is offered by, and performed with, wheeled overground mobility aids such as walkers and rollators and gait trainers. Users who are quite weak or otherwise unbalanced may find it difficult to release the rail. It would be desirable to have continuous upper body support when walking along a rail(s) of a railed device. This would safeguard and improve gait kinematics. It would be desirable to have continuous mobile support enabling the UEs to move simultaneously, as is performed during three point gait, as well as continuous support enabling the UEs to move independently of each other, such as in alternating fashion such as during four and two point gait patterns. Clinical needs exist for unilateral as well as bilateral, mobile and static UE support on railed devices. Parallel rails offer a good substrate for training in proper incorporation of the upper extremities in gait, particularly with the assistive devices presented herein. Devices with two rails are the most frequently used type of rail system used by individuals with one-sided UE involvement in rehabilitation. Gait training using these devices and subsequently training with overground mobility aids such as walkers, hemiwalkers, and canes, is lacking in terms of mechanical means to address support and movement of an involved upper limb(s). Asymmetrical upper and lower body movement and weight bearing result. It would be desirable to have a device which offered mobile unilateral UE support on the rail for addressing rehabilitation of the weaker UE while the stronger limb grabs the rail for support. A device is also needed which provides bilateral mobile UE support, to facilitate training in symmetrical gait patterns which could be continued with novel overground mobility aids which offer support and enable reciprocation UE movement. Mobile UE assemblies are needed to improve gait kinematics, including movement and function of the upper extremities and the upper body in railed devices. On mobility aids such as walkers and rollators, forearm platform support assemblies are incorporated to accommodate decreased ability to manage the device by gripping, for postural support, for provision of additional support such as is needed by the bariatric population and other users with significant generalized or lower body weakness, for training in minimization of upper body weight bearing, among other reasons. Forearm support assemblies are also needed for these same reasons on railed devices. A gripping surface can be attached to a standard grip of a walker, for example, which conforms to a hand, to improve contact and control in the presence of gripping dysfunction. It would be desirable to have a support surface for use on railed devices, which accommodates a hand, in order to facilitate gripping contact. This may be needed unilaterally, bilaterally, or in combination with a forearm support assembly. A mobile grip handle support would also be useful to facilitate work on arm movement during walking, in users with normal UE function. One can also envision support assemblies which would accommodate other portions of an upper limb in addition to forearm and grip presented above, such as axillary support. Orthoses to accept the distal end of various levels of amputated limbs could also be secured to a mobile assembly.
Crossover Arm Design
The crossover arm design is functional on railed devices comprised of two parallel rails. The crossover arm design Assembly includes a hinged interconnecting member (crossover arm assembly) which interconnects two (2) housings, each resting upon one rail of the device which has two parallel rails. An UE support surface (forearm support assembly or grip handle assembly, or other) is attached to a housing to create a mobile UE support assembly. A support surface may be attached to one or both housings, depending on the desired functionality as will be described. The mobile housing and support surfaces are the same components used for the unilateral system #1, described below. The crossover arms provide for rotational stabilization of the housings about the rails. Additional functional attributes of this feature will be explained below and include the following: enablement and facilitation of bidirectional walking when unilateral support is needed; static symmetrical/parallel positioning of housings; provision of a mechanical delimitation of excursion distance between UEs; enablement of bidirectional walking when bilateral support is needed; visual and mechanical enhancement of alternating placement of UE assemblies, and others.
This entire assembly can be used for either unilateral or bilateral UE support for use when a user faces a direction which is parallel to the rails, as well as for unilateral support when the user faces perpendicular to a rail such as for side stepping activities. Unilateral support is enabled by moving one of the housings fore or aft along the rail, such that the user can grip the rail with one first hand or allow the first UE to be unsupported while the second UE is supported. For side stepping, when the user faces perpendicular to a rail, the support surface is rotated 90 degrees for support of one UE. The housing which rests on the opposite rail is positioned to accommodate the user's body, and the central hinge is locked in place. In this way, the entire assembly moves as a one piece unit when the user steps. The two (2) crossover arms are hinged together by the central hinge. A lock bar spans the angle formed by the central hinge and can be locked or unlocked depending on desired functionality as outlined below. A hinge secures the opposite end of each of the crossover arms to each of the two respective housings.
A locking mechanism could be introduced to these hinges.
The assembly can be used bidirectionally, i.e. hinged linkage in front of or behind the user, irregardless if used for unilateral or bilateral UE support. When used for bilateral UE support, the hinged linkage can be statically positioned by a locking mechanism or lock bar such that the supports remain statically positioned (symmetrically or asymmetrically) relative to each other, or the central hinge on this linkage can be unlocked which allows the two assemblies to be asymmetrically positioned and moved independently upon the rail.
An UE support assembly can be used for static support on the rail by tightening the brake knob. Static support is also achieved by engaging the hand brake lever during use. Various functionalities provided for, by securing central linkage only, securing all three hinges, or enabling free movement at all three hinges.
An assembly is provided whose (housing) can glide past vertical uprights, hence offering UE support along an entire length of parallel bars.
The assembly can variably be mounted by directly placing upon the rail, first removing and later replacing, a part encased in the housing.
An assembly is provided which offers unilateral UE support for lateral ambulation activities.
An assembly is provided which offers unilateral or bilateral static UE support. UE support assembly offers unilateral or bilateral mobile UE support.
An assembly is provided which can be made to glide with variable resistance.
An assembly is provided which can be (hand-) braked in order to cease movement of one or both housings along rail.
Assembly can be used bidirectionally, used for unilateral or bilateral UE support such that continuous walking can be performed, promoting endurance and gait training, and to encourage training in stepping turns in railed devices.
An assembly is provided which is functional irregardless of positioning relative to the body (in front of, or behind). This enables walking facing the opposite/reverse direction; this enables clinician access to the user from the front of the body, unencumbered.
An assembly is provided which offers bilateral UE support with UEs fixed in static positioning relative to each other. Proper posture, e.g. if forearm supports incorporated for this functionality; safety related to braking and variable resistance functionalities; continuous support advanced, such as for step to, three point gait, as can be accomplished with walkers, as opposed to discontinuous support involved when rails are necessarily gripped and released in order to advance.
An assembly is provided which offers bilateral UE support, whereby movement of one assembly, except for constraints placed in regards to maximum linear separation between assemblies, is independent of movement of the opposite support assembly. As such, the two UE support assemblies can function independently of each other.
An assembly is provided which facilitates reciprocating UE movement of one UE support assembly along one rail.
An assembly is provided which facilitates alternating placement of UEs as the user advances within the rails of a bilaterally railed device.
An assembly is provided which offers bilateral UE support, with limitation of maximum separation distance between assemblies (which offers a safety feature, and clinical benefit as excursion distance between placed UE supports can be variably set).
An assembly is provided which enables interchangeable UE support surface(s) in any combination: grip handle/forearm support; grip handle/grip handle; forearm support/forearm support. One can also envision introduction of other support surfaces such as axillary crutch support surfaces for crutch training within the safe confines of a bilateral railed device.
An assembly is provided which can be stably positioned on any of multiple devices with parallel rails.
An UE support device is provided which is intrinsically stable upon a device with two parallel rails, hence without the need for extrinsic stabilization.
An assembly which provides bilateral UE forearm support, with forearms statically positioned parallel to each other, and enables improved posture and gait kinematics compared to an alternative device offering statically positioned bilateral forearm support on a parallel rail device.
An assembly which provides bilateral UE support, whereby one or both of the support assemblies can be statically positioned on the rail for stationary activities, and when the user moves relative to the rails, the UEs can move independently of each other.
An assembly which enables training in gait patterns which can be continued with overground mobility aids which enable and facilitate the same patterns of UE movement.
Unilateral UE Support Designs
An assembly is provided which is mobile upon, and which can be stably positioned upon one rail of a railed device. As such, the device offers unilateral UE support when the user is facing or walking parallel to the rail(s) of the device. The housing (variably called the rail linkage assembly) is the component which is positioned upon the rail, which can glide bidirectionally, and which can be statically positioned upon, a rail. An UE support surface assembly is secured to the mobile housing to create a mobile UE support assembly.
UE support surfaces such as forearm support and grip handle can be interchangeably incorporated.
Rotational stability is provided by a stabilizing rail placed below the rail and a rigid interconnecting member connecting the mobile housing and the mobile component housed within the stabilizing rail.
Two design concepts are included. Variable resistance to glide and braking capabilities exist in both. Motion stop blocks delimit the translation range of the housing along the rail. This assembly can be incorporated onto both rails of a rail system with two rails such that both UE of a user can be supported when the user is positioned between the rails and facing parallel to the rails. When assemblies are used in this manner (one on each of two parallel rails), mobile assemblies can be interconnected with the crossover arm hinged linkage described above, if desired.
One can also consider other types of mechanical interconnections between mobile assemblies, which would offer various functionalities, such as reverse motion linkages, a horizontal rigid linkage, among others. When the user faces perpendicular to the rail, and with two support assemblies introduced to one rail, bilateral UE support is enabled for sidestepping activities.
Two alternate devices enabling a support assembly to stably glide along a rail which provides for unilateral UE support are presented as follows: a track secured to one rail, upon which an ‘UE support assembly’ glides; a stabilization bar extending from a mobile support assembly on one rail, to the second rail in a railed device with two rails. Also, mobile UE support can be accomplished without mechanical stabilization of the device on the rail; the user provides active muscular stabilization in order to keep the support assembly in an upright position.
An assembly is provided which provides for mobile forearm support on one rail of a railed device.
An assembly is provided which provides for a mobile grip support on one rail of railed device.
An assembly is provided to which other UE support surfaces (besides forearm support and grip handle support) can be secured in order to support other parts of a user's UE. An assembly is provided which provides for unilateral static UE support on one rail.
An assembly is provided which offers unilateral or bilateral UE support on one rail for side stepping activities. An assembly is provided, offering static unilateral UE support by motion stop blocks. An assembly is provided which can allow mobile UE support within a selected translation distance.
An assembly is provided which can be braked when additional stability is needed.
An assembly is provided which moves along rail with variable resistance. An UE support assembly is provided which offers unilateral mobile support, stabilized by a bar positioned below the support rail. An assembly is provided which glides along a track attached to a rail, and to which an UE support surface can be attached.
Forked linkage: an assembly is provided which provides unilateral UE support and is stable about one rail by incorporating a stabilizing member extending to the second rail of the device with two parallel rails. Unilateral UE support, unstabilized: an assembly is provided which can be used on one rail without mechanical stabilization components. The user provides active stabilization of the assembly in the upright position.